They explain that the intervention, which took place at a rural primary care practice in the southeastern United States, involved 16 sessions of behavioral treatment tailored to each patient’s baseline level of distress (measured by the Diabetes Distress Scale [DDS]-17) and depression (measured by the Patient Health Questionnaire-9).

Patients with lower levels of distress and depression received small-changes lifestyle coaching, while those with higher levels received CBT, all delivered by a team of trained behavioral providers. Each session lasted between 30 and 60 minutes and all patients were re-evaluated after 6 months, with the intervention intensity adjusted at this point if necessary.

After 12 months, mean glycated hemoglobin (HbA1c) had fallen by 0.92%, from a baseline of 9.8%, in the 67 patients who received the intervention, and by 0.31%, from a baseline of 9.4%, among the 72 patients who received usual care.

And although the difference between the groups did not reach statistical significance, the investigators describe the fall observed in the intervention group as “clinically significant, particularly for patients living within a rural geographical region with historically high rates of diabetes morbidity and mortality.”

Furthermore, improvements in HbA1c significantly correlated with improvements in RRD and medication adherence.

Of note, the majority (73.7%) of study participants were African American and women (77.7%) but the researchers found that similar results were observed regardless of race or sex.

Cummings et al conclude: “Taken together, the current study is among one of the only randomized trials demonstrating that a tailored, integrated care model can result in improvements in both behavioral and glycemic outcomes in a rural primary care setting.”

However, they add that “despite the improvement in HbA1c, mean values remained substantially above target at 12 months follow-up, and more aggressive pharmacologic treatment may be needed as psychological symptoms are reduced.”

“Therefore, continuing to develop treatment models that integrate both medical and behavioral care in order to maximize treatment outcomes is critical.”